Management of pediatric corneal limbal dermoids

Abstract

This paper reviews the data in the published literature (PubMed from 1937 to 2011) concerning the medical and surgical management of pediatric limbal dermoids. Current standard medical treatment for grade I pediatric limbal dermoids (ie, with superficial corneal involvment) is initially conservative. In stages II (ie, affecting the full thickness of the cornea with/without endothelial involvement) and III (ie, involvement of entire cornea and anterior chamber), a combination of excision, lamellar keratoplasty, and amniotic membrane and limbal stem cell tranplantation are advocated. Combinations of these approaches seem to yield better and more stable long-term ocular surface cosmesis and fewer complications in comparison with traditional methods of excision and lamellar keratoplasty. Management of amblyopia (i.e. occlusion treatment, chemical penalization with/without spectacle wear, etc) must continue after surgical excision to yield optimal results when or if the surgery is done at a younger age.

Canine Bilateral Conjunctivo-Palpebral Dermoid: Description of Two Clinical Cases and Discussion of the Relevance of the Terminology

“…The treatment is always surgical and obviously requires resection of the malformed area, sometimes associated with graft procedures [3,[27][28][29]. During the surgery, particular care must be taken in reconstruction of the palpebral margin in order to conserve palpebral function and remove any risk of iatrogenic ocular irritation.…”

Shave Excision With Keratopigmentation for Limbal Dermoid

“…Often, grade I dermoids require no surgical intervention if astigmatism is less than 1 diopter (D). 1,2,7,8 Cases with greater than 2 D astigmatism call for early surgical intervention in patients less than 6 years and at high risk of amblyopia. 2 Our patients had presented in the second decade of life and were desirous of good cosmesis but reluctant to use cosmetic contact lens in the postoperative period.…”

“…1 They may be associated with irregular astigmatism, amblyopia, tear film abnormalities, or chronic irritation. 2 Surgical removal with functional rehabilitation is indicated in such cases.…”

Amniotic Membrane Grafts in Pediatric Corneal Limbal Dermoids with Conjunctival Eyelashes: A Case Presentation

“…It was first used as a substitute for rabbit peritoneum [12] in the management of ocular chemical burns and now has a varied amount of uses, including its use in recurrent corneal erosion and severe dry eye. Amniotic membranes are being used as grafts due to their ability to reduce postoperative pain, corneal neovascularization and inflammation that leads to scarring due to its in-vitro inhibition of TGF B [13].…”